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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:So we have a very sick baby in the NICU. I was the resident on call last night.

So last night we were carefully monitoring the gases in his blood because he's on a ventilator. Here's the deal.

1) If the oxygen gets low two things happen:
a) not enough oxygen to the tissues (i.e. BRAIN!!!)
b) acid builds up, which affects the hemoglobin, which makes it less able to bind oxygen, which makes more acid build up, which affects the hemoglobin, whcih makes it less able to bind oxygen, which makes more acid build up, which affects the hemoglobin, which makes it less able to bind...get the idea?

2) If the amount of carbon dioxide gets too low, then acid builds up, which affects the hemoglobin, which makes it...well, you know.

3) If the amount of carbon dioxide gets too HIGH, then the blood vessels think that you're hyperventilating and start clamping down, which means that blood may not get to the brain.

So, I was working with a respiratory therapist whose job it was to get blood gases at 6PM, 9PM, 12AM, 3AM, and 6AM. Now, I had to go to the delivery room to deliver a baby at 2:30AM, so when I got back to the NICU at 3:15AM I learned that the respiratory therapist hadn't been there. So we paged him and told him that the patient's ventilator settiings had drifted and that the patient needed a blood gas. He said "OK, I'll be down." I'm used to being able to trust people, so I made a near-fatal mistake: I went to the on-call room to take a nap.

Turns out the respiratory therapist didn't show up until 5AM. And the baby's blood was WILDLY basic and the carbon dioxide levels were ABSURDLY low. Which means...that the blood vessels in his brain were probably clamped closed. FOR HOURS.

Now, you might say, "Well, gee, it wasn't your fault..." Except it *IS* my fault because as the physician on call I am directly responsible for the patient's care. What I *SHOULD* have done was check at 3:30 to make sure that the respiratory therapist had shown up. I didn't *KNOW* that I could draw the blood gas by myself and have it run at the lab, I thought the therapist had to do it because I thought they were the only people who could run blood gases.

So because the therapist didn't do his job and didn't call me to tell me that he couldn't do his job because he was busy, the patient may have suffered brain damage. And I rightfully got yelled at by the attending this morning. Because apparently I can't trust the therapist to do his job, so now I have to check up on him because when he doesn't do his job, I'm responsible for it and ultimately my attending is responsible for it.

It's one of those days when I'm *THIS* close to resigning. That baby may have severe brain damage and it's *MY* mess. frown

-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura


Location: York University
Member Since: 16th May 2005
Total posts: 1762
Posted:Why would you resign? All that would do is stop you helping others. From your posts, you seem like a person who takes his morality seriously. So you made one small mistake, and it might have hurt someone. But bear in mind it's not through your own direct action (or lack thereof), it's because the therapist wasn't doing his job. If he tells you "I'm on my way" you expect (quite rightly) that a medical professional will do what he says.

The only reason why any health service works at all is through meticulous communication between personnel. If *he* couldn't make it, he should have said. You made your request in perfectly clear language. His mistake, not yours.

I'm not going to say that it had nothing to do with you, because I wasn't there.

But I WILL say that you have a *long* medical career ahead of you, you only qualified relatively recently, and like everyone, you have made a mistake. It is *so* easily done to think "It can't hurt". Especially when it seems like someone else is on shift.

You give every indication of liking your job, especially in your accounts of how the children on your ward smile when you're there. Ultimately, IMO, you sound like a great Doctor, and a conscientious man. I would like to think that you can help many, many more people by staying in the Medical profession, and doing your steadfast best in the job.


After much consideration, I find that the view is worth the asphyxiation.
I may disagree with what you have to say, but I will defend to the death your right to say it.


trusty sidekick to superman
Location: oxford, england, uk
Member Since: 23rd Feb 2003
Total posts: 799
Posted:o lovely. sounds like you haven't had the best day in the world. huuuuge virtual hug s coming your way.

It is terrible that you cant trust people to do their jobs in environments like hospitals where peoples lives are completely put in your hands. It sounds like quite a large part of the blame should be put on the respiratory therapist to me. Even though you were in charge of checking he was doing his job, ultimately it was him who wasn't doing the job properly.

Everyone has days when they make big mistakes. You just have to think that even though you did make a mistake, you still tried your hardest and whats done is done and try to move on. I've read your posts on here before about your work, and it sounds to me like even though you've only been qualified a while, you've done a blooming damn good job and really got a lot out of seeing the people you help get better. You may feel terrible now, but try not to let one day get you too down. Your doing a good job man. We need more people who are genuinely caring in the world.

really hope he's ok. keep us informed on how its going hug2

Livin' on dreams and custard creams

Location: London/ Surrey
Member Since: 15th May 2003
Total posts: 1359
Posted:I'll bet the therapist isn't thinking of resigning, he's got the shield of hiding behind the fact that someone else should have checked. If you resign, it's one less person that cares that the job is done properly, leaving the ones that don't do their job properly. Not a good thought. Stick with it hug

The optimist claims that we are living in the best of all possible worlds.
The pessimist fears this is true.

Always make time to play in the snow.

Location: lost
Member Since: 29th Jul 2005
Total posts: 1247
Posted:We all make mistakes, directly, and indirectly. Doctors too! There are always new mistakes to be made, some due to lack of knowledge, some miscommunication, and some just cause some days, we [censored] up. Don't let that stop you. You work in an environment where a fairly simple common mistake can have huge consequences. I can only imagine how intense that sense of responsibility must be. That makes you all very, very careful.

Yet, despite our best efforts, sometimes [censored] happens. You did what you thought was appropriate, with the knowledge you had.
Ask yourself if there is anything within this experience that could be used to make sure it never happens again- analyse the error, thoroughly and make the necessary changes toimprove the system if needed, and prevent future difficulties as much as is possible. It sounds like you have already been doig this. In hindsight, you see how it could have been done differently, but that is hindsight. Take it into the future. Now that you know better, you will do better...

Learn from this mistake, forgive yourself, and continue offering the best of yourself to your proffession. Sethis said it amazingly well,and I agree- moving on from this you have a lifetime ahead of you as a doctor, and many will benefit from your care if you continue: vs. none if you resign.

Hugs to you, prayers for the baby, and thanks for sharing

"God *was* my co-pilot, but then we crashed, and I had to eat him..."

King Of Bongo
King Of Bongo

Location: Berlin
Member Since: 25th Dec 2002
Total posts: 522
Posted:first post I've read on this site for ages,
all I can say is:
I'm sure you're a gr8 doc from all the previous posts you've made that i've ever read. I know it doesn't help much but i'm not sure of what else to say to cheer you up!
all the best

Your life is ending one minute at a time...
So live it.


Carpal \'Tunnel
Location: Preston
Member Since: 10th Jul 2005
Total posts: 2666
Posted:Aw dont beat yourself up, people in hospitals work looooong hours you had probablybeen up all night saving lives and being a great doctor, i knew this doctor couple (ones a GP the others a...well I dunno what she is but shes really important) and from the snippets of conversation Ive heard and general talk I know how important it is to work a a team in hospitals and along the way its very stressfull and hard work but every doctor/nurse consultant, paramedic, whatever your particular role is will tell you its such a rewarding job most of the time.

It sounded to me like it wasnt any of your faults, you where called off to deliver a baby or something, and you said the...blood gas guy got called to do something else (wich would have been important), neither of you chose to not see to the baby so theres no use in beating yourselves up on it, there are people who do stuff like that unfortunatly, but you aint one of them. Things happen in life and its unfortunate alot of the time (to say the least) but no one can help these things, its just how the randomness that the universe is works.

Chief adviser to the Pharaoh, in one very snazzy mutli-coloured coat

'Time goes by so slowly for those who wait...' - Whatever Happend To Baby Madonna?

100 characters max...
Location: Sydney, NSW, Australia
Member Since: 11th Jan 2002
Total posts: 2996
Posted:Written by: Doc Lightning

It's one of those days when I'm *THIS* close to resigning. That baby may have severe brain damage and it's *MY* mess. frown

Don't you bloody well dare. You learnt a lesson, and you should go and apply this lesson. That is what life is about. That is what every job is about. If you don't go forward and become a better Doctor because of this, what does that say?

Not only that, but if someone else replaces you, who does not know what this guy is like. Well, they will have to learn that lesson too, and they may not be as lucky. You don't just have a responsibility to apply your knowledge, you have a responsibility to keep that important knowledge in your organisation.


I respect you very much. I know you are capable of not just being a brilliant doctor with facts at his fingertips, but a responsible diligent doctor.

It was a day for screaming at inanimate objects.

What this calls for is a special mix of psychology and extreme violence...


Location: melbourne, victoria, australia
Member Since: 2nd Nov 2004
Total posts: 2084
Posted:yes, you f**ked up, and it'll might take you quite a while to come to some sort of acceptance about this. but you know what? people do f**k up, constantly. people in all professions do, and it affects them and others to varying degrees. responsible people recognise their f**k ups, learn from them them, and ensure they don't repeat them. irresponsible people may feel bad for getting in trouble about it, blame others around them, and keep f**king up. now just from reading your post i can see that you are in the former group. so from here all you can really do is whatever you can to minimise the harm that's potentially occured to the bub, and work on your feelings about this. talk to your supervisor to get a bit of perspective. i'm reallym sorry that you are going through this. try to be as gentle to yourself as you can for a while, you're in a high pressure job at the best of times, beating yourself up is just going to make things harder for you, and make it harder to do your job. i hope that you, the bub and his family are coping ok. hug

Location: Greece-Samos-Athens
Member Since: 1st Jun 2004
Total posts: 80
Posted:you should talk to other doctors and have a council.

"For once there was an unknown land, full of strange flowers and subtle perfumes,
a land of which it is joy of all joys to dream, a land where all things are perfect and poisonous."
"Put out the torches! Hide the moon! Hide the stars!"

Location: Greece-Samos-Athens
Member Since: 1st Jun 2004
Total posts: 80
Posted:A doctor that gives up is a bad doctor. Just try to do your job as well as you can and dont put blames on you.Leave that for the others.... BAD BAD BAD BAD doc! hug

"For once there was an unknown land, full of strange flowers and subtle perfumes,
a land of which it is joy of all joys to dream, a land where all things are perfect and poisonous."
"Put out the torches! Hide the moon! Hide the stars!"


Location: On the far left of sane
Member Since: 28th Jul 2005
Total posts: 72
Posted:You have obviously learned from your mistake.
Its obvious from your post that you will do your damnedest to never make that same mistake again, so dont beat yourself up over it.

Personally i think heaping all the blame on yourself is unfair. As the physician on call you may be professionally responsible. But thats buerocracy for you, they need a procedure for something like that. But in the human world, no-one would put all the blame on you. Im not saying that none of the blame should go your way, but to be fair, it should not be all of it.

As for resigning, dont be daft.
You know better now. You have more experience. If you resign and have to be replaced by someone new, they'll make the same mistakes, or worse ones. And you'll still feel guilty. Let the guilt go, and continue to do your job to the best of your ability.

I am not a bitch.
I am THE bitch.
And Im Miss Bitch to you.


had her carpal tunnel surgery already thanks v much
Location: Edinburgh
Member Since: 27th Jan 2005
Total posts: 4145
Posted:Hi Doc,

so sorry to hear about this, and a big hug

I don't think you'll resign, since you love your job and you say yourself you're only close to doing it, and that's a good thing smile

Not telling you anything new here, BUT:
People in all jobs make mistakes. As a doctor, the things you do right do more good than that of many other professions, and the mistakes you make can be more grave, unfortunately. It's one of the reasons I went for toxicology and pharmacology instead of medicine, because I was scared of the immediate responsibility. I admire everyone who takes that responsibility upon them to help people. You didn't know you could check the blood gases yourself, so it's all part of a learning curve. Maybe it can even help you identify other similar situations that could come up and ask the right questions in advance! Weigh the mistake against the good you can do in the next 35 years or so and STICK TO YOUR JOB smile

"vices are like genitals - most are ugly to behold, and yet we find that our own are dear to us."
(G.W. Dahlquist)

Owner of Dragosani's left half


mostly a muppet in need of distraction...
Location: bristol
Member Since: 10th Jul 2005
Total posts: 305
Posted:ok...so maybe at an extreme long shot u might be indirectly responsible for not getting bloods done all night..but you didnt make the baby sick in the first place and things happen.If you quit then you wouldnt be helping anyone and because of misplaced trust (where you dont even know if there is permanent damage) you'd be giving up the chance to help thousands more people day in day out.
We all make mistakes its part of being newly qualified and even the oldest of doctors cock up occasionally. one of our top consultants allowed a patient to have a glass of champagne to celebrate post op and it ended in a full blown medical emergency - the point is that you learn.
cheer up tomorrows another day! hug

Build a man a fire and he'll be warm for a day, set a man on fire and he'll be warm for the rest of his life.


.:*distracted by shiny things*:.
Location: brizvegas
Member Since: 13th Oct 2003
Total posts: 3776
Posted:hug i still reckon you are an awesome doctor! smile & you care about your patients which is wonderful. i'm sure it sometimes adds to your stress because it plays on your mind, but you're only human! ditto to everything everyone has said!!

big squishy hug2 for you doc!!

do not meddle in the affairs of dragons, for you are crunchy and good to eat!

if at first you do succeed, try not to look too astonished!

smile! grin it confuses people!

Are we there yet?
Location: australia
Member Since: 14th Mar 2001
Total posts: 1897
Posted:last time I looked none of us were perfect angel2 just muddling along doing the best we can

I admire that you can reflect on and learn from your actions


linden rathen
linden rathen

Carpal \'Tunnel
Location: London, UK
Member Since: 2nd Mar 2005
Total posts: 6942
Posted:ade im perfect i just hide it very well tongue

doc hug's to you many many hug's i know a lot of ppl who are doctors or paras and they all have tails like this

youve learnt from it. you wont do it again and you'll be more careful in the future. people may blame you but they have no reason to

if you dont get told that person x can be a bit forgetful or something then you cant be expected to know

while yes maybe you should of checked up on the kid the same thing could have happened if you'd been called away or any other number of things.

dont beat yourself up and dont resign - or else ill get on a plane and beat you back into hospital

many hugs m8 and keep it up your amazing hug


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